High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction

Vergouw, Leonie J.M.; Egal, Mohamud; Bergmans, Bas; Dippel, Diederik W.J.; Lingsma, Hester F.; Vergouwen, Mervyn D.I.; Willems, Peter W. A.; Oldenbeuving, Annemarie W.; Bakker, Jan; Jagt, Mathieu van der

doi:10.1177/0885066617732747

Cited by 27 publications

(20 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings of this study provide support and confirm those of previous studies, 2,4 and pave the way for further, preferably multicenter, investigations on early hemodynamic and fluid management as an essential part of critical care management of aneurysmal subarachnoid hemorrhage.…”

Section: To the Editorsupporting

confidence: 88%

Letter by van der Jagt and Suarez Regarding Article, “Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled Trial”

Jagt

Suárez

2021

Stroke

Self Cite

View full text Add to dashboard Cite

Section: To the Editorsupporting

confidence: 88%

Letter by van der Jagt and Suarez Regarding Article, “Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled Trial”

Jagt

Suárez

2021

Stroke

Self Cite

View full text Add to dashboard Cite

“…Higher fluid intake in aSAH has been associated with significant complications, such as pulmonary edema, prolonged intubation, DCI, and poor functional outcomes. 225,226 The HIMA-LAIA trial was the first RCT investigating the role of induced hypertension in DCI. The trial did not demonstrate any benefit in the induced hypertension group with a risk ratio for serious adverse events of 2.1 (95% CI, 0.9 to 5.0), although the trial was ended early because of negative results and slow recruitment.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage

Tawk

Hasan

D'Souza

et al. 2021

Mayo Clinic Proceedings

122

View full text Add to dashboard Cite

Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.

show abstract

“…For example, euvolemia is currently recommended in patients with brain injury, given increasing evidence found that both hypovolemia and hypervolemia are associated with unfavourable outcomes [ 30 ]. Vergouw et al investigated 246 patients with aneurysmal subarachnoid haemorrhage and reported that an increased early day 1–3 fluid input was associated with the incidence of delayed cerebral ischemia [ 31 ]. Similarly, Rass et al recently reported that a higher day 1–2 fluid input, instead of day 1–2 fluid balance, was associated with the outcome, including prolonged mechanical ventilation, early brain oedema, anaemia, delayed cerebral ischemia and 3-month functional status, in 237 patients with non-traumatic subarachnoid haemorrhage enrolled between 2010 and 2016.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, in line with our data, Rass et al illustrated daily fluid balance from day-1 to day-15 after the incident of subarachnoid haemorrhage and explicitly demonstrated that fluid balance generally reaches a stable status on approximately day-6/day-7 after the subarachnoid haemorrhage, suggesting the crucial role of fluid balance in critically ill neurological patients [ 32 ]. Unlike increasing studies that have shown a slightly increased comorbidity and mortality rate among critically ill neurological patients with a positive fluid balance in days 1–3, evidence of the impact of fluid balance beyond day-3 is sparse [ 31 , 33 ]. Hence, the data in the present study provide crucial evidence regarding the long-term mortality impact of day 4–7 fluid balance in critically ill surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan

Pai

Wong

et al. 2021

JCM

View full text Add to dashboard Cite

Fluid balance is an essential issue in critical care; however, the impact of early fluid balance on the long-term mortality in critically ill surgical patients remains unknown. This study aimed to address the impact of day 1–3 and day 4–7 fluid balance on the long-term mortality in critically ill surgical patients. We enrolled patients who were admitted to surgical intensive care units (ICUs) during 2015–2019 at a tertiary hospital in central Taiwan and retrieved date-of-death from the Taiwanese nationwide death registration profile. We used a Log-rank test and a multivariable Cox proportional hazards regression model to determine the independent mortality impact of early fluid balance. A total of 6978 patients were included for analyses (mean age: 60.9 ± 15.9 years; 63.9% of them were men). In-hospital mortality, 90-day mortality, 1-year and overall mortality was 10.3%, 15.8%, 23.8% and 31.7%, respectively. In a multivariable Cox proportional hazard regression model adjusted for relevant covariates, we found that positive cumulative day 4–7 fluid balance was independently associated with long-term mortality (aHR 1.083, 95% CI 1.062–1.105), and a similar trend was found on day 1–3 fluid balance, although to a lesser extent (aHR 1.027, 95% CI 1.011–1.043). In conclusion, the fluid balance in the first week of ICU stay, particularly day 4–7 fluid balance, may affect the long-term outcome in critically ill surgical patients.

show abstract

High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction

Abstract: High early fluid input was associated with DCI. Invasive hemodynamic monitoring was feasible to reduce fluid input while maintaining preload. These results indicate that fluid loading beyond a normal preload occurs, may increase DCI risk, and can be minimized with TPT.

Cited by 27 publications

References 43 publications

Letter by van der Jagt and Suarez Regarding Article, “Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled Trial”

Letter by van der Jagt and Suarez Regarding Article, “Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled Trial”

Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage

Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan

Contact Info

Product

Resources

About